Khuri-Bulos N A, Abu Khalaf M, Shehabi A, Shami K
Department of Pediatrics, Jordan University Hospital, Amman.
Infect Control Hosp Epidemiol. 1994 May;15(5):311-4. doi: 10.1086/646918.
To describe an outbreak of salmonella food poisoning that probably was due to contamination of mashed potatoes by a foodhandler, which occurred despite a policy for routine surveillance stool cultures of kitchen employees.
A case control study of 223 individuals who ate the lunch meal on September 23, 1989, at the Jordan University Hospital (JUH) cafeteria.
Tertiary care university hospital in Amman, the capital of Jordan.
Individuals who developed loose stool or vomiting 6 to 72 hours after eating the lunch meal of September 23, 1989, at the JUH cafeteria.
Of 619 individuals, 183 fit the case definition (attack rate, 19.6%); 150 were employees, 26 were inpatients, and seven were visitors. Twelve other employees became sick 4 to 6 days later and probably were infected secondarily. The incubation period ranged from 16 to 72 hours in 183 instances. Symptoms included diarrhea (88%), fever (71%), abdominal pain (74%), dehydration (34%), and bloody stool (5%). Eighty-four were hospitalized. Cultures of eight food items were negative, but stool culture on 90 of 180 patients and 11 of 61 kitchen employees yielded Salmonella enteritidis group D. A cohort study of 223 individuals revealed a food-specific attack rate of 72% for the steak and potato meal and 18% for the rice and meat meal (RR, 4; CI95, 2.62 to 6.24; P < 0.01). Stratified analysis of the steak and potato meal revealed that the potatoes were implicated most strongly (RR, 1.93; CI95, 1.42 to 2.64; P < 0.01). Cultures were obtained from all kitchen employees, and 11 of 61 grew Salmonella enteritidis group D. One asymptomatic, culture-positive employee prepared the mashed potatoes on September 23. All of these employees had negative stool cultures 3 months earlier.
This outbreak probably was caused by massive contamination of mashed potatoes by the contaminated hands of the foodhandler. Routine stool culture of foodhandlers is not cost-effective and should not be used as a substitute for health education and proper hygienic practices.
描述一起沙门氏菌食物中毒暴发事件，其可能是由于一名食品处理人员污染了土豆泥所致，尽管有对厨房员工进行常规粪便培养监测的政策，但该事件仍发生了。
对1989年9月23日在约旦大学医院（JUH）自助餐厅吃午餐的223人进行病例对照研究。
约旦首都安曼的三级护理大学医院。
1989年9月23日在JUH自助餐厅吃午餐后6至72小时出现腹泻或呕吐的人。
在619人中，183人符合病例定义（罹患率为19.6%）；150人为员工，26人为住院患者，7人为访客。另外12名员工在4至6天后发病，可能是继发感染。183例的潜伏期为16至72小时。症状包括腹泻（88%）、发热（71%）、腹痛（74%）、脱水（34%）和便血（5%）。84人住院治疗。对8种食品的培养均为阴性，但180例患者中的90例以及61名厨房员工中的11名粪便培养检出肠炎沙门氏菌D组。对223人的队列研究显示，牛排和土豆餐的食品特异性罹患率为72%，米饭和肉餐为18%（相对危险度为4；95%可信区间为2.62至6.24；P<0.01）。对牛排和土豆餐的分层分析显示，土豆的关联性最强（相对危险度为1.93；95%可信区间为1.42至2.64；P<0.01）。对所有厨房员工进行了培养，61人中有11人培养出肠炎沙门氏菌D组。一名无症状、培养结果呈阳性的员工在9月23日制作了土豆泥。所有这些员工3个月前粪便培养均为阴性。
此次暴发可能是由于食品处理人员受污染的手对土豆泥造成了大规模污染。对食品处理人员进行常规粪便培养不具有成本效益，不应作为健康教育和正确卫生习惯的替代措施。
